Early clinical double-blind study with S-adenosyl-L-methionine: a new potential antidepressant.
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Biomedical subjects
Publications and source records attributed to B Küfferle.
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A case is presented of lithium intoxication with therapeutic doses of lithium, owing to the additional administration of a sodium-excreting diuretic. Since the patient was receiving neuroleptic therapy at the same time, intoxication symptoms at the onset were falsely attributed to neuroleptic extrapyramidal effects. The possible effects of widely-used diuretics in conjunction with lithium therapy are presented. The combination of both therapeutic substances is possible, but calls for extreme caution and strict control of medication, diet and serum lithium levels.
Clozapine, a new antipsychotic drug without extrapyramidal side effects and with strong sedating potency, can produce acute symptoms of central anticholinergic toxicity. The authors report that physostigmine, a reversible anticholinesterase agent, which can pass the blood-brain barrier, was effective in reversing the clozapine-induced brain syndrome in two patients. Physostigmine also reduced one patient's tachycardia.
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The literature was surveyed concerning the frequency and conditions for confusional states and deliria following Amitriptyline and Clozapine treatment, and certain discrepancies were noted. As a result a retrospective comparative investigation was carried out as to the frequency and the conditions for such events in a group of patients treated along the same lines. While our experience with Amitriptyline is not different from that reported by others, this does not seem to be the case with Clozapine. Confusional states and deliria are four times as frequent as the average reported in the literature; it is clear that they depend on conditions different from those of confusional states and deliria due to Amitriptyline; there is a slightly significant (p less than 0.05) correlation between the appearance of confusion and a temperature of over 37.5 degrees C. The anticholinergic properties of Amitriptyline and of Clozapine cannot explain the difference in frequency, nor the differing conditions for the appearance, of pharmacogenic confusional states and deliria with those two substances.
Conditions of outbreak and chronification of paranoid syndromes, including the existence of an "axial syndrome" and behaviour theories are hypothetically summarized. The individual characteristics of patients with the first paranoid symptoms during involution appear to depend mainly on three factors: the theme of the delusion seems to be connected with the age at the onset, in more than half of the male patients exogenous psychoorganic symptoms were observed, and in females however predominantly manic-depressive syndroms could be found.
Clinical-psychopathological and electroencephalographic investigations are reported, carried out on patients with delusions of the paranoic and of the paraphrenic types. Abnormal EEGs were found more frequently in patients with a paraphrenic syndrome, and there was also a relatively more frequent response to flickering lights than in the paranoic group. There was also a more frequent response to flicker in patients with auditory hallucinations. Psychopathologically more florid delusional syndromes appear to produce abnormalities in the EEG more readily than do psychopathologically less elaborate syndromes.
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